Thorax - Anatomy Question Bank (MGR University)

ESSAY QUESTIONS (Long Answer - 10-12 Marks)

Chest Wall & Bony Thorax

1. Describe a typical intercostal space - its contents, arrangement of structures, and clinical importance. Add a note on the site for pleural tapping.
2. Describe the sternum with its parts, ossification, and clinical importance.
3. Describe the diaphragm - its attachments, openings with structures passing through each, nerve supply, blood supply, and applied anatomy. Explain why infant respiration is abdominal.

Pleura & Lungs

1. Give an account of the pleura - its parts, reflections, recesses, nerve supply. What is the site of choice for inserting a needle to drain pleural fluid, and why?
2. Describe the root and hilum of the lung with the arrangement of structures.
3. Describe bronchopulmonary segments of the right and left lung. What is their clinical importance?
4. A patient diagnosed with pleural effusion - give a brief account of pleura with its recesses, nerve supply, and the anatomical basis for pleural tapping.

Heart

1. Describe the pericardium - its layers, sinuses (transverse and oblique), blood supply, nerve supply, and clinical importance.
2. Describe the interior of the right atrium - its features and the development of the interatrial septum. What are its anomalies?
3. Describe the interior of the left ventricle and compare it with the right ventricle.
4. Describe the coronary arteries (arterial supply of the heart) under the following headings: origin, course, branches, area supplied, and clinical importance.
5. Describe the conducting system of the heart with its clinical importance.
6. Describe the fibrous skeleton of the heart and its significance.
7. Describe the venous drainage of the heart.
8. Write about Tetralogy of Fallot - anatomical defects, embryological basis, and clinical features.
9. Describe the development and blood supply of the interventricular septum. Add a note on its anomalies.

Mediastinum

1. Describe the superior mediastinum - its boundaries and contents.
2. Describe the arch of the aorta - its relations, branches, and development. Add a note on the ligamentum arteriosum.
3. Describe the superior vena cava - its formation, tributaries, relations, and clinical importance.
4. Describe the thoracic duct - its origin, course, tributaries, termination, and clinical importance.
5. Describe the oesophagus - its parts, relations at each part, blood supply, nerve supply, and constrictions. A patient has dysphagia after corrosive ingestion - name the possible sites of stricture.
6. Describe the trachea - its extent, relations, blood supply, and clinical importance.
7. Describe the azygos vein - its formation, tributaries, and clinical importance.

SHORT NOTES (5-6 Marks)

Chest Wall

1. Inlet (superior aperture) of thorax
2. Typical intercostal nerve
3. 1st intercostal nerve (atypical)
4. Internal thoracic (internal mammary) artery - branches and applied anatomy
5. Costodiaphragmatic recess of pleura
6. Nerve supply of the apical pleura
7. Central tendon of diaphragm
8. Subcostal nerve

Lungs & Airways

1. Bronchopulmonary segments of the left lung
2. Root of the lung
3. Respiratory epithelium (histology)
4. Microanatomy (histology) of the lung
5. Lingula of the left lung

Heart & Pericardium

1. Transverse pericardial sinus
2. Oblique sinus of pericardium
3. Left coronary artery
4. Right coronary artery and its branches
5. Coronary sinus - tributaries and termination
6. Conducting system (SA node / AV node)
7. Ligamentum arteriosum (and its developmental significance)
8. Fossa ovalis - development and clinical importance

Mediastinum & Great Vessels

1. Mediastinal surface of the left lung
2. Arch of the aorta - branches
3. Thoracic duct
4. Azygos vein
5. Superior vena cava
6. Constrictions of the oesophagus
7. Histology of the oesophagus
8. Vagus nerve in the thorax
9. Sympathetic chain in the thorax

Embryology / Development

1. Development of the interatrial septum and its anomalies
2. Tetralogy of Fallot
3. Development of the interventricular septum
4. Tracheoesophageal fistula (embryological basis)
5. Coarctation of the aorta

"EXPLAIN WHY" / REASONING QUESTIONS (3 Marks)

1. Why is the central tendon of the diaphragm blended with the base of the fibrous pericardium?
2. Why does tracheoesophageal fistula occur?
3. Why is respiration in infants abdominal, thoracic in adult females, and thoracoabdominal in adult males?
4. Why are segments 2 and 6 (apical and apical-basal) most susceptible to tuberculosis?
5. Why does referred pain from the diaphragm appear at the shoulder tip?
6. Why is a pleural tap done at the 9th intercostal space in the midaxillary line?
7. Why does Horner's syndrome occur in apical lung tumors (Pancoast tumor)?

DIAGRAMS FREQUENTLY ASKED

• Transverse section of thorax at T4 vertebra level (labeled)
• Bronchopulmonary segments of both lungs
• Interior of right atrium
• Interior of right ventricle
• Conducting system of the heart
• Diaphragm (inferior view)
• Transverse pericardial sinus
• Mediastinal surface of right/left lung

HIGH-PRIORITY TOPICS (Repeat Offenders in MGR Papers)

• Essay questions usually follow a clinical/applied format - e.g., "A patient presents with pleural effusion... describe the pleura."
• Short notes on embryology (interatrial septum, coarctation, TEF) are very common.
• Always add applied anatomy / clinical significance for extra marks.
• Labeled diagrams often fetch 2-3 extra marks even when not explicitly asked.

Diagram 1 - Pleural Cavities & Parts of Parietal Pleura

• The difference between parietal pleura and visceral pleura (inset magnified view, top-left)
• The pleural cavity as the potential space between them
• The four named parts of parietal pleura: Costal, Diaphragmatic, Mediastinal, and Cervical (cupola)
• The suprapleural membrane at the apex
• The pulmonary ligament below the hilum
• Overall relationship of pleura to both lungs and the diaphragm

Diagram 2 - Pleural Recesses & Surface Markings (Exam Favourite!)

• The costodiaphragmatic recess - the largest and most clinically important recess (site for pleural tapping)
• The costomediastinal recess anteriorly
• Surface marking lines you MUST memorize for exams:

Key Points to Write in Your Exam Answer

• Parietal pleura - somatic innervation (intercostal nerves for costal part; phrenic nerve for diaphragmatic and mediastinal parts) - PAIN SENSITIVE
• Visceral pleura - visceral afferent (bronchial vessels) - NOT pain sensitive
• Pleural tapping site - 9th intercostal space, midaxillary line (within costodiaphragmatic recess, above the rib to avoid neurovascular bundle)
• Cervical pleura / cupola - projects 2.5 cm above the medial one-third of the clavicle - can be injured in stab wounds to the root of the neck

Source: Gray's Anatomy for Students, Thorax chapter - Pleura section (pp. 201-203)